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Repeat Blood Culture Positive for B. pseudomallei Indicates an Increased Risk of Death from Melioidosis

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  • Department of Tropical Hygiene, Department of Microbiology and Immunology and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine and Department of Clinical Pathology, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Department of Medicine, Cambridge University, Addenbrooke's Hospital, Cambridge, United Kingdom
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Melioidosis, a bacterial infection caused by Burkholderia pseudomallei, is notoriously difficult to cure despite appropriate antimicrobial therapy and has a mortality rate of up to 40%. We demonstrate that a blood culture positive for B. pseudomallei taken at the end of the first and/or second week after hospitalization for melioidosis is a strong prognostic factor for death (adjusted odds ratio = 4.2, 95% confidence interval = 2.1–8.7, P < 0.001 and adjusted odds ratio = 2.6, 95% confidence interval = 1.1–6.0, P = 0.03, respectively). However, repeat cultures of respiratory secretions, urine, throat swabs, or pus/surface swabs provide no prognostic information. This finding highlights the need for follow-up blood cultures in patients with melioidosis.

Author Notes

*Address correspondence to Direk Limmathurotsakul, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithee Road, Bangkok, 10400 Thailand. E-mail: direk@tropmedres.ac

Financial support: This study was supported by the Wellcome Trust.

Authors' addresses: Direk Limmathurotsakul, Department of Tropical Hygiene and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mail: direk@tropmedres.ac. Vanaporn Wuthiekanun, Gumphol Wongsuvan, Sukanya Pangmee, and Premjit Amornchai, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mails: lek@tropmedres.ac, gumphol@tropmedres.ac, sukanya@tropmedres.ac, and kung@tropmedres.ac. Prapit Teparrakkul, Department of Medicine, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand, E-mail: prapith_11@hotmail.com. Nittaya Teerawattanasook, Department Clinical Pathology, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand, E-mail: nidteerawa@hotmail.com. Nicholas P. J. Day, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand and Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, United Kingdom, E-mail: nickd@tropmedres.ac. Sharon J. Peacock, Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, United Kingdom, and Department of Medicine, Cambridge University, Addenbrooke's Hospital, Cambridge CB2 0SP, United Kingdom, E-mail: sharon@tropmedres.ac.

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